Welcome to the Claims Management workflow. This is a step-by-step workflow to complete the task of handling Claims depending on if the insured contacts the agency or the carrier.


This workflow is for agencies with full management system access as we will use the Management System and Client Center products. If you aren't sure if you have all these products, check out our Glossary of Icons and their Meanings - Left Navigation Bar section for product icons.


TABLE OF CONTENTS


Check out our video if you'd rather watch and follow along!
EZLynx Term: Applicant is our term for customer, insured, or account and are used interchangeably.

Follow this procedure guide for best practices on tracking and managing claims. The quality of the claims experience is the barometer by which insureds will judge their entire insurance experience. It offers You, the Agent a unique opportunity to reinforce your position as the Insured’s trusted advisor. 

 

Insured contacts Agency to file claim


Follow these steps when the insured reaches out directly to your Agency to file a claim.

 

Gather information and file the claim with the Carrier.

  1. Gather all the required information (police reports, invoices, etc.).

  2. Add the Claim from the Policy Overview.
    Not sure how? Click here!
    1. On the customer's Overview page, click the Actions button.
    2. Choose Add claim. This will open the Add Claim window. Note: You must have a policy on the account for this option to display.
    3. Use the Select a policy dropdown to choose the policy the claim is for.
    4. Complete as much as you can including the date of loss, where it occurred, claim type, who and what was involved.
    5. Click Save.



  3. Notify the Carrier according to the Carrier and Agency guidelines for filing claims.
    1. Document how you notified the Carrier. Attach any documentation in the discussion.
      Not sure how? Click here!
      1. On the top-right, select the Add Note (paper with a plus) icon. This will open the Agency Workspace pane.
      2. If you are on the customer's account, it will auto-fill their name in the top field. If you are not, then you will need to search for the customer's account.
      3. If this is a new discussion, input the Discussion Title. If this note needs to be added to an already started discussion, search for the previous discussion title. 
      4. Input your notes in the "Type your note here..." box. 
      5. Select the Add Attachments (paperclip) icon to attach any relevant documents needed for reference. 
      6. Select the Add Task (paper with a checkmark) icon to assign a task or checklist to someone at your agency.
      7. Select Add Reminder to add as many reminders (email, text, and/or notification) as needed for the task or checklist.
      8. Select the Add Labels (price tag) icon to add a label to the note for organization.
      9. Select Save to finish adding the note to the customer's account.


       
  4. Update the claim number, adjuster information, and any updates provided by the Carrier as you receive them. 
    Not sure how? Click here!
    1. On the customer's Overview page, find the Claims section.
    2. On the claim, click the Claim Actions (three vertical dots). 
    3. Choose the option that is needed for your updates.



  5. Create a task for the CSR or assigned Agent to follow up with the Carrier if the claim was not closed within 30 days. Add the proper checklist and label.
    Not sure how? Click here!
    1. On the top-right, select the Add Note (paper with a plus) icon. This will open the Agency Workspace pane.
    2. If you are on the customer's account, it will auto-fill their name in the top field. If you are not, then you will need to search for the customer's account.
    3. If this is a new discussion, input the Discussion Title. If this note needs to be added to an already started discussion, search for the previous discussion title. 
    4. Input your notes in the "Type your note here..." box. 
    5. Select the Add Attachments (paperclip) icon to attach any relevant documents needed for reference. 
    6. Select the Add Task (paper with a checkmark) icon to assign a task or checklist to someone at your agency.
    7. Select Add Reminder to add as many reminders (email, text, and/or notification) as needed for the task or checklist.
    8. Select the Add Labels (price tag) icon to add a label to the note for organization.
    9. Select Save to finish adding the note to the customer's account.


 

Keep the Insured updated and document the payments.

  1. If the Carrier downloads claim information, the payments, adjuster, and claim status information, it will automatically match to the policy. 

  2. For non-downloading Carriers, manually update adjuster and payment information as you receive it. Manage additional Carrier follow ups through tasks. 
    Not sure how? Click here!
    1. On the customer's Overview page, find the Claims section.
    2. On the claim, click the Claim Actions (three vertical dots). 
    3. Choose the option that is needed for your updates.



  3. Contact the Insured and provide claim details such as adjuster information and set expectations for the claim process. 
    Not sure how? Click here!
    • Via email:
      1. On the customer's account pane, click the Envelope icon. This will open the Compose Email page. 
      2. Compose your email and Send.
    • Via text:
      1. On the customer's account pane, click on the Text bubble icon. This will open the Text Message pane.
      2. Compose your text and Send.




  4. Once the claim is closed by the Carrier and you receive the communication, update the status to “Closed.” 
    Not sure how? Click here!
    1. On the customer's Overview page, find the Claims section.
    2. On the claim, click the Claim Actions (three vertical dots). 
    3. Choose the option that is needed for your updates.



  5. Send a Link to Client Center to complete claim survey. 
    Not sure how? Click here!
    1. On the customer pane under their name, select the Share icon (three dots connected by two lines).
    2. Choose either Client Center link via text or email. 
      • If you choose text, the Texting pane will open on the right side of the screen. 
      • If you choose email, a new browser window will open up and take you to the Compose Email page. 



  6. Review survey results and follow up as needed. 

Insured contacts Carrier to file claim


Follow these steps to manage the claims when the Carrier initiates the claims process and then sends or downloads the information into the management system.

  1. The Carrier notifies the Agency about receipt of claim from Insured by way of download, email, or fax.
    1. Downloaded Claims will create the Claim in the management system for the policy.
    2. Agents will enter details themselves for manual claims.
      Not sure how? Click here!
      1. On the customer's Overview page, find the Claims section.
      2. On the claim, click the Claim Actions (three vertical dots). 
      3. Choose the option that is needed for your updates.



  2. Agent will enter payment and claim status details as they are received.
    Not sure how? Click here!
    1. On the customer's Overview page, find the Claims section.
    2. On the claim, click the Claim Actions (three vertical dots). 
    3. Choose the option that is needed for your updates.



  3. Attach claim documentation and make Note of conversations in Notes / Task reminders according to the Agency procedures.
    Not sure how? Click here!
    1. On the top-right, select the Add Note (paper with a plus) icon. This will open the Agency Workspace pane.
    2. If you are on the customer's account, it will auto-fill their name in the top field. If you are not, then you will need to search for the customer's account.
    3. If this is a new discussion, input the Discussion Title. If this note needs to be added to an already started discussion, search for the previous discussion title. 
    4. Input your notes in the "Type your note here..." box. 
    5. Select the Add Attachments (paperclip) icon to attach any relevant documents needed for reference. 
    6. Select the Add Task (paper with a checkmark) icon to assign a task or checklist to someone at your agency.
    7. Select Add Reminder to add as many reminders (email, text, and/or notification) as needed for the task or checklist.
    8. Select the Add Labels (price tag) icon to add a label to the note for organization.
    9. Select Save to finish adding the note to the customer's account.



  4. Once the claim is closed by the Carrier and you receive the communication, update the status to “Closed.”
    Not sure how? Click here!
    1. On the customer's Overview page, find the Claims section.
    2. On the claim, click the Claim Actions (three vertical dots). 
    3. Choose the option that is needed for your updates.



  5. Send a Link to Client Center to complete claim survey. 
    Not sure how? Click here!
    1. On the customer pane under their name, select the Share icon (three dots connected by two lines).
    2. Choose either Client Center link via text or email. 
      • If you choose text, the Texting pane will open on the right side of the screen. 
      • If you choose email, a new browser window will open up and take you to the Compose Email page.



  6. Review survey results and follow up as needed.

We hope this workflow article was helpful in learning how to handle claims depending on if the insured contacts the agency or the carrier. Please let us know if this article was helpful by answering the question below. Check out our related articles on the right-side of the page to learn more about EZLynx!